Comprehensive Neurological Examination

Comprehensive Neurological Examination

Joanne V. Hickey


The purposes for conducting a neurological physical examination by the physician are (1) to determine whether nervous system dysfunction is present, (2) to diagnose disease of the nervous system, and (3) to localize disease within the nervous system. Although diagnosis of disease is usually the responsibility of the physician, advanced practice nurses also may conduct the neurological examination. It is the purpose of the data collection that differentiates medical practice from nursing practice. The nursing purposes are (1) to determine whether nervous system dysfunction is present, (2) to identify functional deficits and how they impact on the individual’s ability to function in activities of daily living and other aspects of life, and (3) to determine the human responses to actual or potential health problems precipitated by the dysfunction. The data collected create a database for planning care that is patient centered.

The author wishes to acknowledge the helpful review and suggestions of Bahia Elkamand, RN, BSN in the revisions or this chapter.

Advanced practice nurses may overlap with physicians in the purposes of the examination based on legal authority to practice in advanced practice roles.

The neurological physical examination is included in this text for several reasons. First, the neurological physical examination provides a comprehensive database of critical information about the patient’s neurological function. As part of the patient’s record, it is available to nurses and other health care providers to review. Second, a review of these data by nurses may be helpful in identifying areas of special consideration in neurological assessment, as well as specific observations to be made and documented. These points should be noted in the patient’s individualized care plan. Third, potential multidisciplinary collaborative problems may be suggested by the dysfunction identified. For example, a patient with ataxia, a symptom of cerebellar dysfunction, will usually have problems with balance and coordination and needs supervision when ambulating to prevent falls. The potential for falls and injury must be considered by all providers and noted on the care plan or clinical pathway. Finally, although nurses independently establish an individualized nursing database about the patient’s neurological function, collaborative practice and relationships suggest a sharing of information so that each care provider understands the database on which other providers base their care. The comprehensive neurological examination recorded on admission provides a baseline for documenting a patient’s problems and needs.


A complete discussion of the various components of the LOC is found in Chapter 8. See discussion in the mental status examination (MSE) section.